临床推理：一位 60 岁男性，表现为不对称性肌无力和持续性发热。
Clinical Reasoning: A 60-Year-Old Man With Asymmetric Weakness and Persistent Fever.
机构信息
From the Departments of Neurology (Y.Z.), Zhejiang Provincial Hospital of Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou; Departments of Pathology (J.-J.X.), Rheumatology (X.-F.Z., J.H.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Department of Pharmacy (S.Z.), The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou; and Department of Neurology (M.-P.D.), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
出版信息
Neurology. 2023 Mar 14;100(11):530-536. doi: 10.1212/WNL.0000000000201697. Epub 2022 Dec 12.
Peripheral neuropathies, especially those with atypical features, remain a diagnostic challenge. In this case, a 60-year-old patient presented with acute-onset weakness starting in the right hand then sequentially involving the left leg, left hand, and right leg over 5 days. The asymmetric weakness was accompanied by persistent fever and elevated inflammatory markers. Subsequent development of rashes combined with careful review of the history led us to the final diagnosis and targeted treatment. This case highlights clinical pattern recognition with the help of electrophysiologic studies in peripheral neuropathies, which provide shortcuts to narrow the differential diagnosis. We also illustrate the important pitfalls from history taking to ancillary testing in diagnosing the rare but treatable cause of peripheral neuropathy (eFigure 1, links.lww.com/WNL/C541).
周围神经病，特别是那些表现不典型的，仍然是一个诊断挑战。在这种情况下，一位 60 岁的患者出现了急性发作的无力，从右手开始，然后在 5 天内依次累及左腿、左手和右腿。不对称的无力伴有持续发热和炎症标志物升高。随后出现皮疹，加上仔细回顾病史，使我们做出了最终诊断和针对性治疗。这个病例强调了在周围神经病中，借助电生理研究进行临床模式识别，这为缩小鉴别诊断提供了捷径。我们还说明了在诊断罕见但可治疗的周围神经病病因时，从病史采集到辅助检查中容易出现的错误（eFigure 1，链接在 lww.com/WNL/C541）。
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